Written protocol
Visit schedule, who sees complications, enhancement policy and after-hours coverage.
Surgical Co-Management · Refractive
Refractive Co-Management running an elective, self-pay shared-care program.
Refractive surgery is elective and usually not covered by insurance, so co-management works differently from the Medicare cataract model. The practice and the surgeon each charge for the services they actually provide, and the patient should know who is doing what before surgery.
5Procedures to compare: LASIK, PRK, SMILE, ICL, RLE
Self-payMost refractive surgery, per FDA
PatientChooses the co-managing doctor
WrittenTransfer of care, in both records
Quick answer
Transparent roles, separate services.
A sound refractive co-management program rests on three things: the patient chooses whether to be co-managed and by whom, each doctor is paid only for care they personally deliver, and referrals are never conditioned on the surgeon sending the patient back. Put the plan in writing and share it with the patient.
Key takeaways
- Screen and counsel candidates using your own exam data.
- Refer based on the patient's needs, not a fee arrangement.
- Document the transfer of care in both records.
- Tell the patient which visits you will provide and what they cost.
- Get healthcare legal advice on fee arrangements in your state.
Refractive options side by side.
A quick reference for counseling. Each spoke page has the details and sources.
| Procedure | Best-known fit | Recovery note | Guide |
|---|---|---|---|
| LASIK | Stable myopia, hyperopia or astigmatism with healthy corneas | Vision settles over 2 to 3 months | LASIK co-management |
| PRK | Thin or unusual corneas; flap-trauma concerns | Bandage lens for about 4 to 5 days | PRK co-management |
| SMILE | Myopia with or without astigmatism | Small incision, no flap | SMILE lenticule extraction |
| EVO ICL | Myopia from −3 to −20 D, ages 21 to 60 | Lens implant; cornea untouched | EVO ICL guide |
| Refractive lens exchange | Presbyopes and high ametropes wanting fewer glasses | Same course as cataract surgery | Refractive lens exchange |
Program design
Build it once, use it every time.
Three pieces most practices formalize with each surgeon.
Patient disclosure
A one-page sheet naming each doctor's role and charges, signed before surgery.
Outcome tracking
Log refraction, acuity and complications at each visit so both offices see the same data.
Practice pearl
Track your own outcomes. FDA encourages patients to ask how a doctor's results compare with the device study data, and you can only answer if you record them.
RescueLink
Dry eye care around refractive surgery.
Dry eye is one of the most common reasons refractive patients call. Send an eligible over-the-counter list through RescueLink; your practice earns a 15% participation credit on eligible OTC orders on VisionRescue.com.
- No setup fee, subscription or quota
- One-tap ordering for the patient
- Optional auto-ship on recurring items
- Contact lenses and prescription products are excluded
Frequently asked questions
Can a referral be tied to getting the patient back?
No. A referral should not depend on the surgeon agreeing to refer the patient back for post-op care.
Who decides on co-management?
The patient, after a discussion before surgery.
How are fees handled when insurance does not pay?
Each doctor charges for the care they provide, and the patient should see both charges in advance. State laws on fee splitting vary.
Which procedures belong in the program?
Any your partner surgeons perform. Most programs start with LASIK and PRK and add SMILE, ICL and RLE.
References
- FDA. When is LASIK not for me? FDA
- Review of Optometry. Comanagement essentials, 2015. Review of Optometry
- FDA. What are the risks and how can I find the right doctor for me? FDA
- Every source behind this guide is listed on the Vision Rescue sources page. All sources
About this guide
Written for licensed eye care practices by the Vision Rescue team from manufacturer, FDA, CMS and peer-reviewed sources. Questions: providers@visionrescue.com or 1-855-692-8024.
Important notes and disclosures
Information only. Candidacy, technique and outcomes are decided by the operating surgeon. Co-management arrangements must follow federal and state law. Vision Rescue is a licensed pharmaceutical wholesale distributor.
Make every shared patient predictable.
A written protocol, honest disclosure and shared outcome data keep the patient, the surgeon and your practice aligned.
This page is general information, not legal advice. Consult healthcare counsel about co-management and fee arrangements under federal and state law.